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To drink or not to drink? Identity dilemmas of

men living with HIV
Sakhumzi Mfecane
Published online: 21 Dec 2011.

To cite this article: Sakhumzi Mfecane (2011) To drink or not to drink? Identity dilemmas of men living with
HIV, Agenda: Empowering women for gender equity, 25:4, 8-17
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article

To drink or not to drink? Identity dilemmas

of men living with HIV
Sakhumzi Mfecane

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abstract
For centuries the consumption of alcohol in African societies has been reserved mainly for men. Alcohol use
symbolised status, cultural identity, masculine virility and other virtues of manhood. Recently, these ideas have
been promoted by media advertisements of alcohol as a way to achieve sociability and status, and as part of
African tradition and heritage. During my 14-month ethnographic fieldwork with men living with HIV, I realised
that some of them still drank or aspired to drink despite being ill; but the majority had stopped drinking. This
Article explores the ways that an HIV diagnosis reshapes perceptions of masculinity among men, and therefore
also consumption patterns linked to performances of masculinity. My findings indicate that the diagnosis with
HIV significantly changed the ways men construct their masculinity; but some found it particularly difficult to
stop alcohol consumption. This raises challenges for interventions aimed at curbing alcohol use among the ill:
entrenched notions of excessive alcohol consumption being a feature of African tradition and media portrayals
of drinking as a mark of real manhood can often undermine effective interventions.

keywords
Alcohol consumption, African tradition, gender performance and masculinity, sociability, HIV and ARVs

Introduction
Globally, men consume greater amounts of
alcohol compared to women, and they also
suffer more from the harmful effects of
drinking, like poor health, injuries, disabilities, and deaths (WHO, 2011). For centuries
African societies have treated alcohol
mainly as a drink for men, in particular
adult males (Akeampong, 1996; La Hausse,
1988; Hunter, 1936). Although women consumed alcohol, they did so under different
conditions from men (see Suggs, 1996), and
they have often been condemned for their
drinking behaviour (West, 1997; Pattman,
2001). Research has shown that alcohol
consumption among African men has numerous meanings, including masculine
virility (La Hausse, 1988; Carlson, 1990);

sociability (Karp, 1980; Mager, 2010);

nationhood (Nugent, 2010); status; and cultural identity (Mc Allister, 2006). Drinking
then, is not a simple matter of material
consumption; it is an important arena for
men to perform the culturally acclaimed
markers of masculinity.
To explore drinking and its association
with masculinity, I focus on experiences of
HIV positive men who drank alcohol before
they tested for HIV and enrolled for treatment with antiretroviral (ARV) drugs. As
part of the requirement to adhere to ARV
therapy, HIV patients were instructed to
abstain from alcohol. This requirement is
not limited to my research site. Many
studies have shown that HIV positive patients are normally pressured to alter their

Agenda 90/25.4 2011

ISSN 1013-0950 print/ISSN 2158-978X online
# 2011 S. Mfecane
http://dx.doi.org/10.1080/10130950.2011.630520

pp. 8
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For six months of my 14-month fieldwork, I lived in a village near Hazyview in

the rural Bushbuckridge municipality, Mpumalanga province, South Africa. I shared a
house with the Dlamini family composed of
Mr Dlamini, his wife and two children. Mr
Dlamini was wealthy by local standards. He
was a shareholder in a company based in
Malelane, near the Mozambique border. He
owned six cars, including two new BMW
sedans, a van, a Citi Golf (Volkswagen)
hatch compact vehicle and two trucks. The
Dlaminis lived in Malelane on week days
and returned to Bushbuckridge on weekends. Every weekend when Mr Dlamini was
home his house was occupied by men
coming to visit him. He bought copious
amounts of alcohol to share with his visitors. At least two bottles of expensive
whisky were consumed at his home every
Friday, together with several beers that he
ordered from local shebeens (an informal
drinking place usually unlicensed).
The following day, Mr Dlamini would go
to Mkhuhlu Shopping Mall, near Hazyview,
to purchase more alcohol. He would then
take us to a soccer game to watch his team
play. We would sit near to his car and watch
soccer while drinking alcohol. At the end of
the game we would go back to Mr Dlaminis
house to receive a meal of pap (mielie meal)
and meat from his wife. Later, Mr Dlaminis
friends would go their different ways, either
to drink more alcohol or to be with
their families. Sunday would come and
Mr Dlamini would travel back to Malelane,
leaving me in the company of his two
friends, Lolo and Sandile. Had I abstained

from alcohol during fieldwork, I would have

struggled to befriend these men. Lolo did
not appreciate the company of teetotalers,
because, in his judgment, they were not
real men.
One of the men that Lolo regularly
undermined for not drinking was Zizi, my
friend. Zizi had drunk alcohol before, but
said he stopped because it was causing
too much trouble in my marriage. He then
joined church in pursuit of an alternative
lifestyle. One Thursday afternoon Zizi visited me and we sat on the verandah to chat.
Later I escorted him to his house. We
passed Lolos house and saw him sitting
outside. We greeted him and he simply
nodded and then looked away. On my way
back I stopped at Lolos place to chat with
him. He confronted me with this question:
Now Sakhumzi, what are you doing with
people like these? I explained that Zizi was
helping me with my research and that he
was my friend. I then probed, whats
wrong with Zizi? Is there something I should
know? Lolo replied No, its just that
people like Zizi are not my type of friends.
I mean he doesnt drink; what am I going to
talk with him about? That man talks Bible all
the time. Bible, Bible, Bible! (Fieldnotes,
February 2006
April 2007).

although most men in my research

claimed to have modified their lives in
conformity with demands of treatment,
a minority found alcohol particularly
difficult to abandon
Lolo implies that Zizi is not a real man
because, unlike him, he abstains from alcohol. Real men, then, drink alcohol and they
do so in groups. This way of constructing
masculinity concurs with Mfecane et al.
(2005) and Karp (1980). In Mfecane et al.
(2005), men who socialised through drinking were popularly referred to as Auty.1 The
term denotes a man who is streetwise,
smart and sociable. Its opposite is ibhari,
referring to an aloof man who leads a
disciplined lifestyle and is generally rural
in his manner of being. Drinking men also
refer to him as Mfundisi (Priest) if he
abstains from alcohol. In his research
among the Iteso ethnic group in Kenya,
Karp (1980) shows that an Iteso male
who is unfriendly and aloof (for example

Identity dilemmas of men living with HIV

article

lifestyles as a way to enforce adherence to

treatment (Nguyen, 2005; Cataldo, 2007;
Biehl, 2007; Robins, 2005). Other behavioural
changes expected from HIV positive people
include abstinence from smoking, safe sex,
exercising, and diet (Colvin & Robins, 2010).
Although most men in my research claimed
to have modified their lives in conformity
with demands of treatment, a minority
found alcohol particularly difficult to abandon, and they either continued imbibing, or
sought to continue drinking once they recovered from an AIDS illness. To contextualise their dilemma and show how drinking is
linked to masculinity, I start by sharing my
own experience of socialising with men in
the study site.

article
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refusing to share a drink or meal with

neighbours) is negatively labelled as epog;
a friendly and sociable person is positively
labelled as epaporone (meaning social).
The latter is revered by the society while
the former is stigmatised and may be
labelled a witch. The main gripe against a
man regarded as epog is his refusal to be
drawn into networks of interaction, expressed in the refusal to accept proffered
generosity. In short, the label epog stands
for the refusal to be sociable (Karp,
1980:90). This brings me to a specific set
of questions, namely: How do HIV positive
men who drank alcohol before they got ill,
deal with demands to drink in order to be
regarded as sociable? How does their
refusal to be sociable affect their social
status as men? How do they negotiate these
societal demands to drink, from messages
to transform their lives as ill men? Before
exploring these questions it is necessary to
start with a brief background on the changing meanings of alcohol consumption in
South Africa. This discussion reveals that
drinking among Africans2 is an age-old
practice. The experiences of colonialism,
migrant work, and recent media advertising
have reshaped the meanings attached to it
in very dramatic ways.

How do HIV positive men who drank alcohol

before they got ill, deal with demands to
drink in order to be regarded as
sociable?

Changing meanings of alcohol

consumption
For many years before the colonial encounter, African communities had been brewing
beer from variety of foodstuffs and fruits.
The beer was characteristically low in alcohol content and also nutritious (Crush &
Ambler, 1992). It was consumed mainly as a
beverage used to socialise; to relax after
work; as food; and to perform rituals (Mc
Allister, 2006; La Hausse, 1988). Research
shows that alcohol consumption in African
communities was a highly regulated affair
(Crush & Ambler, 1992). The regulations
were in terms of gender, status and seniority of drinkers. For example, in research by
Hunter (1936) senior males men appear to

10

AGENDA 90/25.4 2011

have had access to copious amounts of

alcohol compared to women and younger
men. Although women brewed beer they
received small shares of alcohol in traditional drinking rituals (ibid). These patterns
of drinking have been changing gradually
over the years due to changes in the means
of production and outside influences, like
colonialism (Mc Allister, 1987; Crush &
Ambler, 1992).
A recent ethnographic study detailing
these changes was conducted by Mc Allister
(2006) among the Xhosa ethnic group. The
research portrays beer drinking as having a
special significance for the studied community. They brewed beer for various reasons,
like performing cultural rituals, building
communal solidarity, resisting colonial influences, and others. However, the patterns
of drinking have been changing over the
years due to changes in diet, the influence
of Christianity, migrant work, and the types
of alcohol being consumed. The research
shows that culture has been renegotiated
and transformed through changes in access
to alcohol, and the types of liquor being
consumed. European liquor has also gained
prominence as an essential cultural commodity in rituals. Alcohol, then, is not just a
material artifact consumed freely by individuals to meet their internal needs. The ways
people drink, the type and amount of alcohol they consume, where, and how they
drink, are shaped and controlled by cultural
rules governing their drinking and their
various ranking in the social structure (Mc
Allister, 2006).
The advent of migrant work also changed drinking patterns and meanings assigned to alcohol by Africans. It gave
African men unrestricted access to Europen
liquor with high alcohol content compared
to traditional African beer (Crush & Ambler,
1992). Migrant work required men to leave
their rural base for several months and stay
in urban settings in order to earn a living by
working in mines and farms. European
liquor became a tool for them to socialise,
relax and curb boredom (Baker, 1992; La
Hausse, 1988; Suggs, 1996). They drank
large amounts of strong liquor in groups,
but did so under different conditions from
those in rural areas, as described above.
The consequences of these changes
have been fatal for certain men, who became alcoholics and died from drinking

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Since the unbanning of liquor laws on

the segregated sale of alcohol, other actors
have played critical roles in shaping drinking behaviour among African communities. Mager (2010) and Nugent (2010)
both emphasise the role played by multinational brewers of alcohol, like South
African Breweries (SAB), in defining the
meanings of drinking and also shaping the
choices of drinks among various racial
groups. SAB portrayed beer drinking as
having the capacity to facilitate sociability
and bonding among men (Mager, 2005).
They did so through media adverts of their
brands, which were designed to communicate specific messages about the quality
of a brand and what is meant to be its
consumer. Different beer brands then
stood for different qualities of manhood
and status (Nugent, 2010); but overall beer
drinking is portrayed as a social rather
than solitary activity, to enhance its appeal
to men.
Another trend has been to market specific brands of beer as part of African
tradition and heritage, to attract African
male consumers (Mager, 2010). This is not
limited to SAB or beer advertising, as the
recent radio advert of Commando Brandy
commissioned by Distell, a prominent
brewer and marketer of wines, spirits and
ciders, shows. It begins by having a highly
revered Xhosa cultural figure known
as Imbongi (Praise-singer) singing praises

for a consumer of Commando Brandy

and referring to him as the Greatness
(Ngangalala) and Man among men
(uyiNdodemadodeni!). It ends with the
following tagline by a man with a deep
masculine voice: I Commando Brandy,
Iimpawu zeNdoda yoQobo! (Commando
Brandy, the Mark of a Real Man!) (Aired
on SABC Radio, Umhlobo Wenene). Africans, then, have been subjected to various
influences by pre-colonial patterns, constructs of African traditions, colonialism,
and media marketing, all of which have
controlled and shaped their drinking behaviour in very specific ways.

overall beer drinking is portrayed as a

social rather than solitary activity,
to enhance its appeal to men
The pressures experienced by HIV positive men to drink are partly a historical
product of these influences. However, they
are also shaped by popular cultures and
contemporary understandings of masculinity. The rest of this Article looks at how
men responded differently to messages
from the HIV clinic to abstain from alcohol
after testing HIV positive. My findings indicate that men who stopped drinking also
transformed some aspects of their masculine identity in conformity with messages
about adherence to treatment; a few men
who continued drinking also resisted messages to change.

Findings
From February 2006 until May 2007, I interacted regularly with 25 men aged between
25 and 50 years, who shared their life
stories with me. Furthermore I gained rich
and detailed data on living with HIV by
attending gender-mixed support groups of
people living with HIV (PLHIV) at the HIV
clinic for 14 months. The support groups are
a platform for HIV positive patients to give
testimonies about their experiences of
using ARVs and how treatment has changed their lives (Robins, 2005). My observations were that these testimonies were
predominantly biased towards painting a
positive picture of ARVs and support
groups. In this context, drinking remained
a taboo topic, even for men who
were struggling to abandon alcohol. The

Identity dilemmas of men living with HIV

11

article

poisonous liquor produced cheaply and

sold to mine workers (La Hausse, 1988).
Their alcoholism was further exacerbated
by systems introduced in wine farms and
mines to reward and attract workers by
giving them daily rations of cheap wine (La
Hausse, 1988; Scully, 1992). Later, the colonial authorities banned the sale of European
liquor to Africans (except a few educated
elite), as well as the brewing and sale of
traditional beer in urban settings (Mager,
2005). They also restricted beer consumption by Africans to alcohol brewed by
government municipalities and sold in community beer halls (Mager, 2005). Instead of
curbing alcoholism, these measures actually exacerbated it. They led to illicit sale of
European liquor in township shebeens, as
well as sale of harmful liquor brewed
illegally by shebeen owners and sold to
men (and women), who were craving a
kick (Kuzwayo, 1996).

article
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narratives I go on to recount, therefore, are

of private and personal experiences shared
with me as a trusted researcher and confidant. But I would be nave to claim that all
stories shared with me were genuine representations of experiences with treatment.
For example, one of my participants who
claimed to have stopped drinking was accused of drinking by his wife in one support
group that I attended in his absence. But I
remain confident that most narratives are
fairly representative of experiences of men,
although I am aware of the limits of qualitative research narratives on health (West,
1990).3

Alcohol, ARV and support groups

Most of my participants said they were
heavy drinkers before doing an HIV test.
They drank in groups of men in shebeens
and bars and used drinking as a strategy to
pursue women. Sam, a 34 year-old man,
reflects on his life before he fell ill:
Next to where I used to stay there is a
shebeen called Kwa Zita. I used to stay
there the whole night. And there were
lots of women. We drank the whole night
and when you go home you go with a
woman (Interview, August 27 2006).
Mathe, a 43 year-old participant, made
similar remarks. He also added that drinking
earned him respect from his peers:
The thing is when you enter a shebeen
you want to show who you are, and if
you have money you fill the table and
everybody starts to look at you. I drank a
lot and I would go to a shebeen alone,
but I would never go back alone [laughter]. Im telling you Sakhumzi, I would
never go back alone! (Interview, February 9 2007).
A few men claimed that they drank mainly
in solitude to relax rather than to show off
and chase women. Zola, a 31 year-old man,
was one of those men:
Most of the time I drank alone; if I drink
with someone it was one guy that used
to stay somewhere there (pointing). But I
did drink five or six bottles. The thing is if
I drank too much I got dizzy, you find
that my eyes are closed and I cant see

12

AGENDA 90/25.4 2011

anything [laughing] (Interview, June 26

2006).
Magwa, a 50 year-old former mine worker,
also drank in relative isolation with his close
friends. He said he was opposed to the
binge drinking that most of the miners
tended to do:
But its not that I aimlessly searched for
alcohol. I just bought my own alcohol,
and we are maybe just two, or I am
alone. Because I never really liked the
noise! No, I never liked that. . .I would just
watch them, I was not raised up like that.
I was raised up to take good care of
myself (Interview, October 4 2006).
These narratives reveal the appeal of alcohol in the lives of men, including those who
claimed to have been mild or lone drinkers.
Only two men in my research abstained
from alcohol before testing HIV positive.
When participants fell ill, they delayed taking HIV tests until they were very ill. Interestingly some of them continued drinking
despite being ill, as Thabo, a 38 year-old
participant, illustrates:
The thing is I used to drink too much
alcohol! . . . But then I started having a
problem of not having appetite for alcohol. I would buy a beer, open it, drink it,
but it didnt settle well in my body. So,
this day I was just walking to the toilet,
but then I collapsed. They tried to lift me
up and they asked Hey, whats going
on? I said I was just trying to go to the
toilet; I also dont know whats going on.
Then I started vomiting, and I also had
diarrhea. And from there I went to the
doctor (Interview, October 4 2006).
Once participants tested HIV positive, they
attended compulsory support groups at the
HIV clinic to receive education about their
condition. Support groups did more than
merely impart information about HIV and
AIDS to the new clients. They also provided
guidance on what kinds of lifestyles the
clients should adopt or discard as ill people.
Support groups keenly championed the
discourse of empowerment and change
as necessary preconditions to live productive lives with HIV (Robins, 2005). Clients
were empowered with scientific knowledge about their condition to help them

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The latter were encouraged to resist

pressures to drink. Furthermore, drinking
was labeled a risk factor for HIV clients, as it
seemingly interferes with adherence to
ARVs and is generally harmful to health.
Support groups therefore appeared as guardians of the new lives (Robins, 2005) that
HIV positive clients were expected to live.
This new life is often referred to as therapeutic citizenship in academic literature
(Nguyen, 2005; Colvin & Robins, 2010).
In a previous study (Mfecane, 2011), I
showed that other male HIV patients resisted wholeheartedly embracing the identity of therapeutic citizenship as they found
that it constrained their masculine performance. The continued use or non-use of
alcohol by men, which I discuss below,
reflects the participants diverse responses
to these support group messages to transform their lives. They also reveal how men
redefined their masculinity after the HIV
diagnosis.

Alcohol and masculinity

Most participants stopped alcohol after
testing HIV positive and attending support
groups; four confirmed that they still drank,
and two expressed a need to return to
drinking once they recovered from being
ill (they were taking TB treatment). Men
who abstained from alcohol also embraced
support group messages to change; men
who continued drinking were somewhat
resistant to these messages. Let me elaborate on both perspectives, starting with men
who stopped drinking.
Sipho, a 33 year-old participant, used to
drink in shebeens with his friends. He also
had multiple sexual partners who drank
with him in shebeens. He was married
with two children, but hardly spent his
spare time with them. Sipho decided to
quit alcohol after testing HIV positive, and

also to avoid his friends: I dont socialise with them any longer; Im always
with my wife. Someone calls and says
come lets have a drink and I say no I
dont drink. I dont want. Where I now
stay I dont have friends. I dont want
friends because I can see that abangani
bakufaka ngentloko (friends are misleading) (Interview, June 26 2006).

article

deal with conflicting messages from the

society to live risky lifestyles, like drinking,
using traditional medicines, and others.
They were constantly reminded that being
HIV positive meant that they should change
their approach to life and be disciplined
(Robins, 2005). Abstinence from alcohol
became a mark of such change and discipline, particularly for men.

Abstinence from alcohol became a mark

of such change and discipline,
particularly for men.
Most men who stopped drinking became
anti-social; but others formed new friendships with men that they met in church.
They described their drinking peers as
pressuring them to drink and be in sexual
relationships with women. Koko, a 29 yearold participant who abstained from alcohol,
responded to the pressure by being antisocial, as he explains:
I dont socialise a lot these days. Im
always indoors and in the evening I
watch some movies or TV. For example
I like watching Shift (a programme on
SABC TV) because they talk about HIV
(Interview, March 6 2007).
Koko described himself as a changed man.
He had multiple sexual partners before he
became ill and most of them were drinking
women that he met in shebeens. Since
testing HIV positive, Koko had one lover
whom he planned to marry in 2007. He also
joined the Zion Christian Church and became part of the youth choir. The HIV
diagnosis therefore changed Koko holistically. His decision to stop drinking formed
part of other changes that he implemented
in his life as a man living with HIV.
Jozi, a 34 year-old participant, also drank
heavily before he got ill from HIV and he
had multiple sexual partners. But he abstained from alcohol after receiving his HIV
results, and has one girlfriend. He also
severed ties with his drinking peers because
he felt they were too demanding:
The problem is they will be asking too
many questions, so I just distance myself
from them. He will be curious why are
you doing this; why are you doing that

Identity dilemmas of men living with HIV

13

article

and not that? Now I must explain myself

to him (Interview, November 15 2006).
I asked Jozi how he felt about distancing
himself from his friends and he replied:

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Most of them were just drinking buddies. I didnt have close relationships
with them. I still talk to them, like if we
are walking towards the same direction.
One of them asked manje awusaphuzi
vele (do you no longer drink?) I said No,
I have asthma; the doctor said I must
stop drinking (Interview, November 15
2006).
In describing the experiences of men who
abstained from drinking alcohol, I have
argued that abstinence reflects their positive responses to support group messages
to change and be different men. Among
men who continued drinking, the stories of
two participants, Bob and Vusi, exemplify a
rejection of these messages to change. Bob,
a 31 year-old man, has a long history of
resisting HIV messages. First he refused to
do an HIV test while he was sick, until his
family pressured him to test and then enroll
for treatment. Later he stopped using ARVs
saying they made him ill. He also returned
to drinking as soon as he stopped ARVs. He
had plans to abandon his HIV positive
girlfriend and commit to a new girlfriend
that he met from a shebeen near his home.
These reactions attest to Bobs refusal to
embrace support group messages to
change. He still wanted to live according
to his previous life-style.
Vusi, a 32 year-old man, also continued
drinking despite using ARVs. Vusi got ill in
2004 while working as a security officer in
Johannesburg. He returned to Bushbuckridge to receive help, and was immediately
taken to the hospital. He was diagnosed with
TB and then later HIV. Vusi abstained from
alcohol while he was on TB treatment, but
he soon returned to drinking after finishing
his TB treatment and starting ARVs. He
insisted that drinking does not affect his
health: They say we shouldnt mix drugs
with alcohol. I hear them, but I have done it
and nothing happened. By continuing to
drink, Vusi positioned himself as a resister of
support group messages to change. This
resistance is also manifested in other facets
of his life. For example, he rejected support
group messages that encouraged men and

14

AGENDA 90/25.4 2011

women to treat each other as equals. He

believed in the inherent superiority of men
over women and said women ought to live
by the rules set by men:
If she doesnt want to play by your rules
you just tell her leave my house! She
either plays by your rules or leaves your
house. My wife knows; I tell her all the
time if you dont like my rules, leave!
(Interview, February 8 2007).
Vusi later joined a group of dancers who
performed a traditional dance called
Mchongolo, against support group advice
that ill men must refrain from doing physically demanding tasks (including paid hard
work). Vusi insisted on having good health
despite doing hard work as a dancer:
Yhaa, I go there and I dance like other
men. I go up and then go down; up and
down, and I feel nothing! (no pain).
(Interview, February 8 2007).
Vusi told me he wants to get a job,
If someone can offer me a job to start
tomorrow I will take it. And I need a hard
job! Yhaa, a hard job! (Interview, February
8 2007).
Vusi and Bob appear as untransformed
men. They seem determined to undermine
support group efforts to empower HIV
patients with knowledge and skills to resist
pressures from the society to drink and
engage in other risky behaviour, like excessively hard work, multiple sexual partners,
and others. Both later denied having HIV
and this enabled them to pursue their own
goals without worrying about health consequences of their actions.
Lastly, there were men who claimed to
have changed but who found alcohol
particularly difficult to stop. Sabu, a 29
year-old participant, typifies this category
of men. He has not yet resumed alcohol,
but contemplates doing so in the near
future. Sabu could not imagine socialising
with other people without drinking, as he
explains:
I know I dont drink and I dont smoke.
But I just want to know: really does this
mean that I will never drink again in my
entire life, even if maybe they invite me
sometimes. I just want to know, like on

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Sabu illustrates the previously discussed

link between drinking and being social. In
a way, he seems to be worried that complete abstinence from alcohol will place him
in an antisocial category of manhood
called ibhari. But he is equally concerned
about his health, particularly the way drinking may affect his adherence to ARVs. This
makes it difficult for him to decide on how
to move on with his life as a man: drinking
will portray him as sociable, but may also
be a risk factor to his health. This dilemma
renders the picture of living with HIV as a
man far more complex than testimonies
offered in support groups.

Conclusions
I have described various ways that HIV
positive men responded to messages to
abstain from alcohol after enrolling for the
ARV treatment programme. Alcohol is regarded as a risk factor for adherence to
ARVs (Christian et al., 2009; Simbayi et al.,
2004). I have shown that alcohol has been
an important cultural commodity in African
societies, used by most people to perform
rituals; strengthen social ties; and recently,
with the impact of media advertising and
large-scale marketing and sale of different
types of liquor, to achieve a revered status
of being a real man (auty). The latter
meanings assigned to drinking have recast
the teetotalers as antisocial, priestly and
somewhat inferior to drinkers. Most HIV
positive men in my research consumed
large amounts of alcohol before they got
ill, and they viewed it as an important
aspect of their performance of manhood.
But the majority abandoned it after testing
positive, and few men continued drinking or
sought to drink once they recovered from
an AIDS illness. These different responses
have been attributed to the ways men
respond to messages from support groups
to transform their lives and adapt after
testing and enrolling for treatment. Men
who stopped drinking have embraced these
messages compared to men who continued
drinking.

The relationship between alcohol and

masculinity is complex and changes regularly depending on what type of alcohol
men drink; where they drink; as well as
their changing socio-economic circumstances (Suggs, 1996). From my discussion,
it seems as if many working-class men
experience constant pressures to drink as
a way to enhance status and gain acceptance into social networks of drinking men.
They are also subjected to marketing strategies by powerful brewers of alcohol who
market their products through public media
in ways that enhance their appeal to men.

drinking will portray him as sociable

The appeal is strengthened by advertising
these products as markers of African tradition and heritage, thus enticing more
African men to consume them. As consumers of certain brands of alcohol then, men
are made to imagine themselves as consuming symbols of being African, and also
doing so in an African way - like social
drinking and sharing. The negation of teetotalers then, emanates not only from their
rejection of alcohol as a material object, but
also from their seeming dismissal of their
identity as African men. Indeed, as Mc
Allister (2006) reminds us, teetotalers are
also expected to attend drinking rituals and
brew beer for the community, as a way to
demonstrate respect for their tradition.
The trajectories of men who stopped
drinking are instructive in this respect.
Most of them converted to Christianity as
an alternative form of identification. They
believed that church members would not
pressure them to drink alcohol or perform
cultural rituals involving drinking. In short,
the church would be a supportive environment for men to change. But other
churches openly supported the brewing of
traditional beer by their members, including
a church attended by Sipho, one the participants cited above. I visited him one Saturday
afternoon (19 August, 2006) and discovered
that he brewed traditional beer for his church
members, who were scheduled to hold a
prayer at his house on that evening. Some
churches then, seem to offer an alternative
version of being an African man, though
their practices remained marginal to the
dominant societal discourse.

Identity dilemmas of men living with HIV

15

article

the day I drink, will it still be possible for

me to come home late and drink my
medication? Wont it maybe cause me
problems? (Interview, October 26 2006).

article
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My research has raised the significance

of interventions for HIV positive men that
are sensitive to the complex roles played by
alcohol consumption in their gender performances and acquisition of a positive sense
of self. To curb the excessive use and
appeal of alcohol among men it may be
valuable for interventions to publicise alternative versions of masculinity that actively
repudiate current hegemonic views portraying excessive drinking as a sign on real
manhood
This strategy has been initiated in the
ongoing campaigns by Soul City Institute
(nd) and Brothers for Life (nd) which
educate men about responsible ways of
drinking.
Even more effective responses would
need to tackle the current media advertisements of alcohol which glamourise the
heavy drinking of beer and spirits as a true
mark of African masculinity. It is therefore
noteworthy that plans for new laws seem to
be acutely alert to the social effects of liquor
advertising, especially in relation to destructive performances of masculinity and the
impact on health (Sowetan, 17 December,
2010). Plans for the new laws make it clear
that alcohol consumption, despite its troubling connection to risk-taking masculinity
and disease, continues to be a widely
marketed, consumed and advertised commodity. The impact of this, however, has
not remained unchallenged.

Acknowledgements
Thanks to Deborah Posel and Steven Robins for
organising seminars for me to present the first
drafts of this paper at University of Cape Town
and Stellenbosch University respectively, and to
the audience for their constructive comments.

Notes
1.
2.
3.

16

Also spelled as Outie (Modisane, 2011).

Referring to black South Africans.
Because of the sensitive nature of information
shared by participants I used pseudonyms to
safeguard their confidentiality. I also ensured
them of the confidentiality of information that
they shared with me and that I would be using
pseudonyms to report on the findings of our
interviews. This assurance might have enabled
them to be more open about their experiences
when talking to me compared to the time that
they were in support groups. The research

AGENDA 90/25.4 2011

gained ethical approval from Wits University

ethics board.

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